The widening survival gap is likely due to
differences in the quality of healthcare and access to it,
researchers contend, because health factors alone cannot explain the
changes over two decades.
"The advancements in screening tools and treatment which occurred in
the 1990's were largely available to White women, while Black women,
who were more likely to be uninsured, did not gain equal access to
these life-saving technologies," lead author Bijou Hunt, an
epidemiologist at Mount Sinai Hospital in Chicago, told Reuters
Health in an email.
Past research has examined racial differences in survival for
specific cancers and for cancer in general and found at least some
could be explained by biology. High blood pressure, diabetes and
other health problems that both worsen cancer outcomes and are more
common among blacks have received some of the blame.
Black women are also more likely than whites to have aggressive
breast tumors that don't respond to the most effective treatments.
This basic difference in cancer genetics is another reason given for
differing survival when it comes to breast cancer.
To assess changes in survival trends on a national level, Hunt and
her colleagues looked at mortality rates in the largest U.S. cities
at four different time points: 1990-1994, 1995-1999, 2000-2004 and
They found that during the 20-year span, deaths from breast cancer
fell overall — by 13 percent for black women and by 27 percent for
white women. While a gap was already present in the early 1990s, it
widened considerably with time.
The team's analysis, published in the journal Cancer Epidemiology,
found that during 1990-1994, the rate of breast cancer deaths was 17
percent greater among blacks than among whites. This steadily
increased to 30 percent, then to 35 percent and finally to 40
percent in the last time period they looked at.
The disparity was particularly striking in Memphis, Tennessee, where
the rate of breast cancer deaths among blacks was 27 percent higher
than among whites in 1990-1994 and ballooned to more than two-fold
higher by 2005-2009.
In Los Angeles, the mortality rate among blacks was 24 percent
higher than among whites in 1990-1994 and 71 percent higher in
Wichita, Kansas, which had no significant differences in mortality
rates among blacks and whites at the first time point studied, had a
two-fold increased rate of deaths among blacks in 1995-1999, which
fell to a 57 percent greater mortality rate among blacks by the most
recent time point.
Most, but not all, of the 41 cities included in the final analysis
saw an increase in racial disparities during the study period. This
was not true of New York, however, the largest city included. The
disparity in New York was about the same at the first and last time
points examined, with an 18 to 19 percent greater mortality rate
among blacks than whites, the researchers note.
Several other large cities, including Minneapolis, Miami, Portland
and Las Vegas, did not have any significant differences at all in
mortality rates between blacks and whites at any of the four time
The growing gap in breast cancer deaths among blacks versus whites
was largely caused by a steeper drop in breast cancer deaths among
whites than among their black counterparts, Hunt and her colleagues
Sixteen states experienced a greater than 20 percent decrease in the
white mortality rate, but a less than 10 percent decrease in
mortality among blacks, the researchers report.
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"If genetics were responsible . . . we would not have seen the
rates go from being nearly equal in most places at the first time
point to being so much worse for Black women than for White women at
the last time point," Hunt told Reuters Health.
Increased screening and treatment options among whites, coupled with
both a lack of access to and lower quality of screening and
treatment among blacks appear to be the more important culprits, she
and her coauthors speculate in their report.
Dr. Otis W. Brawley, chief medical officer for the American
Cancer Society, agrees with this assessment. He told Reuters Health
that he gets "frustrated" when experts focus on biological
differences between blacks and whites — "issues that we can't fix" — instead of logistical issues such as increasing access to care.
Brawley, a medical oncologist and epidemiologist at Emory University
in Atlanta, Georgia, was not involved in the current study.
The "power" of Hunt's study, Brawley said, is the authors' ability
to show different mortality curves for different cities.
"Black people in New York are not genetically different from black
people in Chicago, but their outcomes are different," he said.
In Chicago, the study found, mortality rates were initially
insignificant between blacks and whites in 1990-1994, but were 48
percent greater among blacks by 2005-2009.
"Most of the disparities are actually due to access to care and
access to quality care," Brawley said. "This is an ethical and moral
problem that we in the United States have yet to come to grips
Brawley added that a "pet peeve" of his is that much attention is
given to screening and early diagnosis, but there is a lack of focus
on increasing access to care and quality care.
"This is not new science, this is getting old science to people who
deserve it because they are human beings," he said. "That is where
we as a society are failing."
Individuals also have a role to play in ensuring they get proper
care, he added. "Once one has insurance and has access to care, one
needs to be focused and involved in one's care," Brawley said, such
as asking questions and learning about the disease.
Breast cancer is the second-leading cause of cancer death among U.S.
women, after lung cancer. It is diagnosed in close to 1.3 million
people around the world every year and kills 500,000.
Cancer Epidemiology, online March 4,
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